Freud's Free Clinics

“Treatment will be free”
1918
THE GERMAN psychoanalyst Max Eitingon wrote in 1925 that his colleagues
could no longer honestly argue that “the factor of the patients
paying or not paying has any important influence on the course of the
analysis.” 1 But Eitingon was merely announcing the fulfillment of
Freud’s forecast from the 1918 Budapest speech on the conscience of society.
In that speech Sigmund Freud had explicitly disavowed his prewar
position, “that the value of the treatment is not enhanced in the patient’s
eyes if a very low fee is asked,” 2 and had repudiated his earlier
1913 image of the psychoanalyst/ physician as medical entrepreneur. 3
Until the end of his life Freud supported free psychoanalytic clinics,
stood up for the flexible fee, and defended the practice of lay analysis,
all substantive deviations from a tradition of physicians’ privilege and
their patients’ dependence. His consistent loathing of the United States
as “the land of the dollar barbarians” echoed his contempt for a medical
attitude he believed to be more American than European, more
conservative than social democratic. 4 This broad revision in his view of
doctors’ fees from 1913 to 1918 resulted partly from the grievous material
and psychological deprivations the Freud family endured during the
war and partly from momentous shifts in the larger political landscape
of the early twentieth century.
Freud’s sense of civic responsibility was not new. As a child he had witnessed
the 1868 installation of the aggressively liberal Bürgerministerium
(bourgeois ministry) that promoted religious tolerance and progressive